Marion Henderson

Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial

Abstract Objective: To determine whether a theoretically based sex education programme for adolescents (SHARE) delivered by teachers reduced unsafe sexual intercourse compared with current practice. Design: Cluster randomised trial with follow up two years after baseline (six months after intervention). A process evaluation investigated the delivery of sex education and broader features of each school. Setting: Twenty five secondary schools in east Scotland. Participants: 8430 pupils aged 13-15 years; 7616 completed the baseline questionnaire and 5854 completed the two year follow up questionnaire. Intervention: SHARE programme (intervention group) versus existing sex education (control programme). Main outcome measures: Self reported exposure to sexually transmitted disease, use of condoms and contraceptives at first and most recent sexual intercourse, and unwanted pregnancies. Results: When the intervention group was compared with the conventional sex education group in an intention to treat analysis there were no differences in sexual activity or sexual risk taking by the age of 16 years. However, those in the intervention group reported less regret of first sexual intercourse with most recent partner (young men 9.9% difference, 95% confidence interval −18.7 to −1.0; young women 7.7% difference, −16.6 to 1.2). Pupils evaluated the intervention programme more positively, and their knowledge of sexual health improved. Lack of behavioural effect could not be linked to differential quality of delivery of intervention. Conclusions: Compared with conventional sex education this specially designed intervention did not reduce sexual risk taking in adolescents.

Is Parenting Associated with Teenagers' Early Sexual Risk-Taking, Autonomy And Relationship with Sexual Partners?

CONTEXT: Extensive research has explored the relationship between parenting and teenagers’ sexual risk-taking. Whether parenting is associated with wider aspects of teenagers’ capacity to form satisfying sexual relationships is unknown. METHODS: Self-reported data were collected in 2007 from 1,854 students, whose average age was 15.5 years, in central Scotland. Multivariate analyses examined associations between parenting processes and sexual outcomes (delayed first intercourse, condom use and several measures reflecting the context or anticipated context of first sex). RESULTS: Parental supportiveness was positively associated with all outcomes (betas, 0.1–0.4), and parental values restricting intercourse were positively associated with all outcomes except condom use (0.1–0.5). Parental monitoring was associated only with delayed intercourse (0.2) and condom use (0.2); parental rules about TV content were associated with delayed intercourse (0.7) and expecting sex in a relationship, rather than casually (0.8). Frequency of parental communication about sex and parental values endorsing contraceptive use were negatively associated with teenagers’ delayed intercourse (–0.5 and –0.3, respectively), and parents’ contraceptive values were negatively associated with teenagers’ expecting sex in a relationship (–0.5). Associations were partly mediated by teenagers’ attitudes, including value placed on having sex in a relationship. CONCLUSIONS: Parents may develop teenagers’ capacity for positive and safe early sex by promoting skills and values that build autonomy and encourage sex only within a relationship. Interventions should promote supportive parenting and transmission of values, avoid mixed messages about abstinence and contraception, and acknowledge that teenagers may learn more indirectly than directly from parents about sex.

The Quality of Young People's Heterosexual Relationships: A Longitudinal Analysis of Characteristics Shaping Subjective Experience

CONTEXT Research on young peoples sexual relationships often overlooks subjective experiences and enjoyment. Perceived quality of sexual relationships may be related to gender, background characteristics, circumstances of first intercourse and subsequent sexual history. METHODS Longitudinal data from 13-16-year-olds who participated in randomized trials of school sex education in either Scotland (N=5,356) or England (N=6,269) were used to examine young peoples subjective experiences of heterosexual relationships. Logistic regression models tested for associations between selected variables and pressure and regret at first intercourse, pressure and enjoyment at most recent intercourse, and three measures of relationship quality. RESULTS Of the 42% of youth who reported having had sex by follow-up, most assessed their first and most recent sexual relationships positively. Greater proportions of females than of males felt pressure at first sexual intercourse (19% vs. 10%), regretted their first time (38% vs. 20%) and did not enjoy their most recent sex (12% vs. 5%). Younger age at first sex was an important correlate of partner pressure and regret at first intercourse (odds ratios, 2.0 each, for those 13 or younger vs. 15-16-year-olds). Negative experiences were associated with less control (e.g., feeling pressure, being drunk or stoned, and not planning sex) and with less intimacy (e.g., sex with a casual partner and less frequent sex). Background social characteristics had limited influence compared with circumstances of first intercourse and subsequent sexual history. CONCLUSION Most young people evaluated their early sexual experiences positively. The quality of relationships was enhanced by better communication and greater physical intimacy. For a vulnerable minority, however, early sexual experiences were negative. They could be protected by delaying first intercourse, restricting sexual activity to established relationships and learning skills to improve control in sexual encounters.

Do television and electronic games predict children's psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study

Background Screen entertainment for young children has been associated with several aspects of psychosocial adjustment. Most research is from North America and focuses on television. Few longitudinal studies have compared the effects of TV and electronic games, or have investigated gender differences. Purpose To explore how time watching TV and playing electronic games at age 5 years each predicts change in psychosocial adjustment in a representative sample of 7 year-olds from the UK. Methods Typical daily hours viewing television and playing electronic games at age 5 years were reported by mothers of 11 014 children from the UK Millennium Cohort Study. Conduct problems, emotional symptoms, peer relationship problems, hyperactivity/inattention and prosocial behaviour were reported by mothers using the Strengths and Difficulties Questionnaire. Change in adjustment from age 5 years to 7 years was regressed on screen exposures; adjusting for family characteristics and functioning, and child characteristics. Results Watching TV for 3 h or more at 5 years predicted a 0.13 point increase (95% CI 0.03 to 0.24) in conduct problems by 7 years, compared with watching for under an hour, but playing electronic games was not associated with conduct problems. No associations were found between either type of screen time and emotional symptoms, hyperactivity/inattention, peer relationship problems or prosocial behaviour. There was no evidence of gender differences in the effect of screen time. Conclusions TV but not electronic games predicted a small increase in conduct problems. Screen time did not predict other aspects of psychosocial adjustment. Further work is required to establish causal mechanisms.

Cognitive impact of a research-based school sex education programme

The cognitive impact of a research-based, teacher-delivered sex education programme for 13–15-year olds (SHARE) was evaluated in 25 Scottish schools. The relationship between cognitions targeted by SHARE and the sexual behaviour of teenagers who had first sexual intercourse after receiving sex education was assessed. The belief that there are alternatives to sexual intercourse in romantic/sexual relationships and the intention to resist unwanted sexual activities were significantly correlated with delayed sexual intercourse. An extended theory of planned behaviour, including descriptive norm and anticipated regret, provided a good model of the cognitive correlates of consistent condom use, explaining 25.9% of the variance. The impact of the SHARE programme on targeted cognitions was compared to that of conventional sex education by means of a randomised controlled trial, taking account of school effects. Those receiving SHARE had significantly higher scores on the belief that there are alternatives to sexual intercourse in romantic/sexual relationships, intentions to resist unwanted sexual activities and intentions to discuss condoms with sexual partners. SHARE recipients were also less likely to agree that condom use would interrupt sexual fun and reduce sexual enjoyment. However, mean differences between trial arms were small and no significant differences were found for the strongest cognitive correlates of consistent condom use, including the intention to always use a condom.

Teenagers' use of sexual health services: perceived need, knowledge and ability to access.

Introduction An individual teenagers use of services may depend on perceived need, on knowledge of sexual health and local services, and on ability to access. This paper presents the first UK large-scale quantitative analysis of these factors, comparing those who use services with those who do not. Methods 15/16-year-olds (n = 5747) were questioned about their use of sexual health services in the SHARE trial of a school sex education programme in 25 schools in Lothian and Tayside, Scotland, UK. Multilevel statistical models examined the role of different factors on service use. Results One-third of teenagers had used a service, and use was strongly related to sexual experience. In addition, some family influences and being a school leaver were associated with service use, although we found no evidence for class, ethnic or religious barriers to use. Proximity to specialist clinics was linked with greater use, while low spending money and high parental monitoring were associated with less use. Teenagers with better knowledge, who rated their school sex education as effective, who were comfortable talking about sex and who had discussed contraception with peers were more likely to have used services. Differences in use relating to sexual experience, knowledge, feeling comfortable talking about sex and talking with peers helped to explain gender differences in service uptake. Conclusion There is potential to influence service use through better knowledge and confidence imparted through school sex education, and by improving the links between services and schools.

Extending social cognition models of health behaviour

A cross-sectional study assessed the extent to which indices of social structure, including family socio-economic status (SES), social deprivation, gender and educational/lifestyle aspirations correlated with adolescent condom use and added to the predictive utility of a theory of planned behaviour model. Analyses of survey data from 824 sexually active 16-year-olds (505 women and 319 men) tested three hypotheses. Firstly, social structure measures will correlate with behaviour-specific cognitions that predict condom use. Secondly, cognition measures will not fully mediate the effects of social structural indices and thirdly, the effects of cognitions on condom use will be moderated by social structure indices. All three hypotheses were supported. SES, gender and aspirations accounted for between 2 and 7% of the variance in behaviour-specific cognitions predicting condom use. Aspirations explained a further 4% of the variance in condom use, controlling for cognition effects. Mothers SES and gender added an additional 5%, controlling for aspirations. Overall, including significant moderation effects, of social structure indices increased the variance explained from 20.5% (for cognition measures alone) to 31%. These data indicate that social structure measures should to be investigated in addition to cognitions when modelling antecedents of behaviour, including condom use.

Contraceptive method at first sexual intercourse and subsequent pregnancy risk: findings from a secondary analysis of 16-year-old girls from the RIPPLE and SHARE studies.

Purpose Existing failure rate studies indicate that typical use of oral contraception (OC) results in fewer unplanned pregnancies than condom use, even among teenagers. However, comparative data on pregnancy risk associated with different contraceptive methods are lacking for younger teenagers starting their first sexual relationship. This study examined associations between contraceptive method at first intercourse and subsequent pregnancy in 16-year-old girls. Methods Six thousand three hundred forty-eight female pupils from 51 secondary schools completed a questionnaire at mean age 16 years; 2,501 girls reported sexual intercourse. Logistic regression (N = 1952) was used to model the association of contraceptive method at first intercourse with pregnancy. Results At first intercourse (median age 15 years) 54% reported using condoms only, 11% dual OC and condoms, 4% OC only, 4% emergency contraception, and 21% no effective method. Method used was associated with a similar method at a most recent intercourse. One in 10 girls reported a pregnancy. When compared to use of condoms only, greater pregnancy risk was found with no effective method (odds ratio [OR] 2.97, 95% confidence interval [CI] 2.12–4.15) or OC only (OR 2.44, 95% CI 1.29–4.60). Pregnancy risk for dual use and emergency contraception did not differ from that for condoms only. Both significant effects were partially attenuated by adjusting for user characteristics and sexual activity. Conclusions Young teenagers may use OC less efficiently than condoms for pregnancy prevention. The characteristics of those using OC-only confirm vulnerability to unintended pregnancy, and suggest that alternative contraceptive strategies should be considered for these young women.

Does early sexual debut reduce teenagers' participation in tertiary education? Evidence from the SHARE longitudinal study.

Negative effects of early sexual debut on academic outcomes can extend beyond secondary school, although concurrent changes in other psychosocial risk factors have not been investigated. Data from three waves of a longitudinal survey of Scottish teenagers were used to examine associations between early sexual debut (first heterosexual intercourse) and both expectations for (N = 5,061) and participation in (N = 2,130) tertiary education at college or university. Early debut was associated with reduced tertiary education, after adjusting for academic performance and wave 1 confounders relating to social background, attitudes and behaviours. Pregnancy/partner pregnancy did not explain all of this finding, as many sexually experienced teenagers opted out of tertiary education after leaving school early for other reasons. Changes in other psychosocial risk factors between waves 1 and 2 mediated much of the association found. Early sexual experience may predict disengagement from tertiary education, although further research is needed to explore causal pathways.

Retaining young people in a longitudinal sexual health survey: a trial of strategies to maintain participation

BackgroundThere is an increasing trend towards lower participation in questionnaire surveys. This reduces representativeness, increases costs and introduces particular challenges to longitudinal surveys, as researchers have to use complex statistical techniques which attempt to address attrition. This paper describes a trial of incentives to retain longitudinal survey cohorts from ages 16 to 20, to question them on the sensitive topic of sexual health.MethodsA longitudinal survey was conducted with 8,430 eligible pupils from two sequential year groups from 25 Scottish schools. Wave 1 (14 years) and Wave 2 (16 years) were conducted largely within schools. For Wave 3 (18 years), when everyone had left school, the sample was split into 4 groups that were balanced across predictors of survey participation: 1) no incentive; 2) chance of winning one of twenty-five vouchers worth £20; 3) chance of winning one £500 voucher; 4) a definite reward of a £10 voucher sent on receipt of their completed questionnaire. Outcomes were participation at Wave 3 and two years later at Wave 4. Analysis used logistic regression and adjusted for clustering at school level.ResultsThe only condition that had a significant and beneficial impact for pupils was to offer a definite reward for participation (Group 4). Forty-one percent of Group 4 participated in Wave 3 versus 27% or less for Groups 1 to 3. At Wave 4, 35% of Group 4 took part versus 25% or less for the other groups. Similarly, 22% of Group 4 participated in all four Waves of the longitudinal study, whereas for the other three groups it was 16% or less that participated in full.ConclusionsThe best strategy for retaining all groups of pupils and one that improved retention at both age 18 and age 20 was to offer a definite reward for participation. This is expensive, however, given the many benefits of retaining a longitudinal sample, we recommend inclusion of this as a research cost for cohort and other repeat-contact studies.